White Timothy O, Jenkins Paul J, Smith Richard D, Cartlidge Christopher W J, Robinson C Michael
Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, Little France, Scotland EH16 4SU, United Kingdom.
J Bone Joint Surg Am. 2004 Nov;86(11):2366-76. doi: 10.2106/00004623-200411000-00002.
Although adult respiratory distress syndrome is an important early complication of blunt trauma, the epidemiology and risk factors for its development remain poorly defined. The aims of this study were to determine the prevalence and demographics of this complication in a prospective cohort series of patients admitted to the hospital following injury. We also assessed the contribution of the severity and pattern of the injury to the risk of this complication developing. By identifying factors associated with the highest risk of the development of adult respiratory distress syndrome, we aimed to produce guidelines to facilitate earlier detection.
We prospectively studied 7192 patients admitted to a single university hospital, over an eight-year period, for treatment of a traumatic injury. With the exception of patients who had sustained a hip fracture or who had been discharged within seventy-two hours after admission, all patients who required hospital admission following trauma, were older than thirteen years of age, and were a resident within the catchment area were included in the analysis. The prevalence and demographics of posttraumatic adult respiratory distress syndrome were identified for patients who had sustained musculoskeletal, thoracic, abdominal, and head injuries, either in isolation or in combination. The relative risks of this condition developing were calculated according to the injury pattern. Multiple logistic regression analysis was performed to identify the most highly significant predictors of the development of adult respiratory distress syndrome.
Adult respiratory distress syndrome developed in thirty-six (0.5%) of the patients. The prevalence was significantly higher among younger patients (p = 0.002), and 83% of the cases followed high-energy trauma. The prevalence of adult respiratory distress syndrome after isolated thoracic, head, abdominal, or extremity injury was <1%. Patients with injuries to two anatomical regions had a higher prevalence (up to 2.9%), and those with injuries to three anatomical regions had an even higher prevalence (up to 10.2%). Multiple logistic regression analysis showed the Injury Severity Score, the presence of a femoral fracture, the combination of abdominal and extremity injuries, and observations of compromised physiological function on admission each to be an independent predictor of the later development of adult respiratory distress syndrome.
The prevalence of adult respiratory distress syndrome increases with injury severity and combinations of injuries to more than one anatomical region. We have been able to quantify the importance and relative risks associated with these injuries. The implications of our findings with regard to facilitating early detection of this complication are discussed.
尽管成人呼吸窘迫综合征是钝性创伤的一种重要早期并发症，但其流行病学及发病风险因素仍未明确界定。本研究的目的是确定在一个前瞻性队列系列中，因伤入院患者中该并发症的患病率及人口统计学特征。我们还评估了损伤的严重程度和类型对该并发症发生风险的影响。通过识别与成人呼吸窘迫综合征发生风险最高相关的因素，我们旨在制定便于早期检测的指南。
我们对一所大学医院在八年期间收治的7192例创伤患者进行了前瞻性研究。除了髋部骨折患者或入院后72小时内出院的患者外，所有因创伤需住院、年龄超过13岁且为集水区居民的患者均纳入分析。确定了单独或合并发生肌肉骨骼、胸部、腹部和头部损伤患者创伤后成人呼吸窘迫综合征的患病率及人口统计学特征。根据损伤类型计算该病症发生的相对风险。进行多因素逻辑回归分析以确定成人呼吸窘迫综合征发生的最显著预测因素。
36例（0.5%）患者发生了成人呼吸窘迫综合征。患病率在年轻患者中显著更高（p = 0.002），且83%的病例发生于高能创伤后。单独的胸部、头部、腹部或四肢损伤后成人呼吸窘迫综合征的患病率<1%。两个解剖区域受伤的患者患病率更高（高达2.9%），三个解剖区域受伤的患者患病率更高（高达10.2%）。多因素逻辑回归分析显示，损伤严重程度评分、股骨骨折的存在、腹部和四肢损伤的合并以及入院时生理功能受损的观察结果均为成人呼吸窘迫综合征后期发生的独立预测因素。
成人呼吸窘迫综合征的患病率随损伤严重程度及多个解剖区域损伤的合并情况而增加。我们已能够量化与这些损伤相关的重要性及相对风险。讨论了我们的研究结果对促进该并发症早期检测的意义。
